Background: Hypertension (HTN) is a major modifiable risk factor and the leading cause of premature deaths globally. The lack of awareness and knowledge have been identified as risk factors in low- and middle-income countries including Bangladesh. Recently, the use of mobile phone SMS text messaging is found to have an important positive impact on HTN management. Objective: The study aimed to develop awareness and knowledge in order to enhance lifestyle behavior changes among individuals with HTN in a rural community of Bangladesh by using health education and mobile health (mHealth) technology (SMS text messaging). Methods: A prospective randomized 5-month intervention, open-label (1:1), parallel-group trial was implemented among the individuals with HTN aged 35 years or older. Both men and women were included. Between August 2018 and July 2019, we enrolled 420 participants, selected from a tertiary level health facility and through door-to-door visits by community health workers. After block randomization, they were assigned to either the intervention group (received SMS text messaging and health education; n=209) or the control group (received only health education; n=211). The primary outcome was the evaluation of self-reported behavior changes (salt intake, fruits and vegetables intake, physical activity, and blood pressure [BP], and body weight monitoring behaviors). The secondary outcomes were measurements of actual salt intake and dietary salt excretion, blood glucose level, BP values, and quality of life (QOL). Results: During the study period, a total of 8 participants were dropped, and the completion rate was 98.0% (412/420). The adherence rates were significantly higher (9%) among the control group regarding salt intake (P=.04) and physical activity behaviors (P<.03), and little differences were observed in other behaviors. In primary outcome, the focused behavior, salt intake less than 6 g/day, showed significant chronological improvement in both groups (P<.001). The fruits intake behavior steadily improved in both groups (P<.001). Participants in both groups had a custom of vegetables intake everyday/week. Physical activity suddenly increased and continued until the study end (P<.001 in both groups). Both BP and body weight monitoring status increased from baseline to 1 month but decreased afterward (P<.001). In case of secondary outcomes, significant chronological changes were observed in food salt concentration and urinary salinity between the groups (P=.01). The mean systolic BP and diastolic BP significantly chronologically decreased in both groups (systolic BP, P=.04; diastolic BP, P=.02.P<.05). All of these supported self-reported behavior changes. For the QOL, both groups showed significant improvement over the study periods (P<.001). Conclusions: Based on these results, we suggest that face-to-face health education requires integration of home health care provision and more relevant and timely interactive SMS text messages to increase the effectiveness of the intervention. Besides, community awareness can be created to encourage “low-salt culture” and educate family members. Trial Registration: Bangladesh Medical Research Council (BMRC) 06025072017; ClinicalTrials.gov NCT03614104; https://clinicaltrials.gov/ct2/show/NCT03614104 and UMIN-CTR R000033736; https://tinyurl.com/y48yfcoo International Registered Report Identifier (IRRID): RR2-10.2196/15523

By classifying older adults, based on chronological age, as a higher risk group of coronavirus disease, 2019 is unacceptable and unfair- potentially reinforcing ageism. This ageist approach can accelerate the risk of social isolation, and heightened levels of psychosocial distress. Moreover, a general calculation of the number that is generated merely from the case fatality rate surely will mislead the indicators of the epidemic’s trajectory, and lead to another infodemic. Therefore, transparency in news dissemination, the underlying health conditions and cultural differences of older adults are essential aspects while defining a risk group.

Pneumonia is the leading cause of death for children under 5 years of age globally, making research on modifiable risk factors for childhood pneumonia important for reducing this disease burden. Millions of children globally are exposed to elevated levels of arsenic in drinking water. However, there is limited data on the association between arsenic exposure and respiratory infections, particularly among pediatric populations. This case control study of 153 pneumonia cases and 296 controls 28 days to 59 months of age in rural Bangladesh is the first to assess whether arsenic exposure is a risk factor for pneumonia in a pediatric population. Cases had physician diagnosed World Health Organization defined severe or very severe pneumonia. Urine collected during hospitalization (hospital admission time point) and 30 days later (convalescent time point) from cases and a single specimen from community controls was tested for urinary arsenic by graphite furnace atomic absorption. The odds for pneumonia was nearly double for children with urinary arsenic concentrations higher than the first quartile (≥6 μg/L) at the hospital admission time point (Odd Ratio (OR):1.88 (95 % Confidence Interval (CI): 1.01, 3.53)), after adjustment for urinary creatinine, weight for height, breastfeeding, paternal education, age, and number of people in the household. This was consistent with findings at the convalescent time point where the adjusted OR for children with urinary arsenic concentrations greater than the first quartile (≥6 μg/L) was 2.32 (95 % CI: 1.33, 4.02). We observed a nearly two times higher odds of pneumonia for children with creatinine adjusted urinary arsenic concentrations greater than the first quartile (≥6 μg/L) at the hospital admission time point. This novel finding suggests that low to moderate arsenic exposure may be a risk factor for pneumonia in children under 5 years of age.

Chronic diseases, including non-communicable diseases (NCDs), have arisen as a severe threat to health and socio-economic growth. Telemedicine can provide both the highest level of patient satisfaction and the lowest risk of infection during a pandemic. The factors associated with its usage and patient adherence are not visible in Bangladesh’s resource-constrained settings. Therefore, this study aimed to identify perceptions about telemedicine among populations with chronic diseases amid the COVID-19 pandemic. A closed-ended self-reported questionnaire was created, and the questionnaire was written, reviewed, and finalized by a public health investigator, a psychiatrist, and an epidemiologist. The data for this study were collected from individuals using simple random sampling and snowball sampling techniques. Ethics approval was granted, and written/verbal consent was taken before interviews. Most of the participants showed a positive attitude towards telemedicine. People aged 35–54 years old and a higher level of education were less frequently associated with willingness to receive telemedicine services for current chronic disease (WRTCCD) than their counterparts. People living in urban areas and lower-income participants were more strongly associated with WRTCCD. Additionally, people who did not lose their earnings due to the pandemic were less strongly associated with WRTCCD. However, the main strength of this research is that it is a broad exploration of patient interest in several general forms of telehealth. In Bangladesh, there are many opportunities for telemedicine to be integrated into the existing healthcare system, if appropriate training and education are provided for healthcare professionals.

Family caregivers endure the burden of caring for patients receiving hemodialysis, which can affect their psychological status and may disrupt the care process. This study aims to assess the level of burden, anxiety, depression, and quality of life (QOL) among family caregivers, to investigate the influence of caregivers’ sociodemographic factors and patients’ clinical conditions on the level of burden, and investigate how burden affects anxiety/depression and QOL. A descriptive, cross-sectional study was conducted from September to October 2020. A total of 104 caregivers with a mean age of 44.4 ± 12.7 years (63.5% women) in the hemodialysis department of a hospital in Indonesia were examined. Zarit Burden Interview (ZBI), Hospital Anxiety and Depression Scale, and WHOQOL-BREF were used. Descriptive analysis was conducted to assess the level of psychological status, and multiple regression analysis and path analysis were performed to evaluate the association among all factors. As result, regarding burden, 10.2% had a moderate-to-severe burden, and in terms of anxiety and depression, 25% and 9.6% showed abnormal cases; the mean scores of 4 domains of QOL were about 60 points. Burden and anxiety/depression were significantly negatively associated with all domains of QOL (p < 0.001); however, sociodemographic and clinical factors were not associated with any of the QOL domains. The path analysis results showed that burden positively correlated with anxiety/depression and negatively correlated with QOL via anxiety/depression. In conclusion, family caregivers’ QOL was found to be indirectly influenced by burden through anxiety/depression. Further evaluation of clinical significance and implications for caregiver’s lifestyle regarding anxiety and depression, which result in caregiver burden, is warranted.

The prevalence of diabetes is rising rapidly across West Africa, posing a significant public health challenge. Effective diabetes management through accessible and quality primary healthcare is crucial, yet multiple barriers persist. This review aimed to synthesise the available evidence on factors influencing access, utilisation, and quality of diabetes primary care in West Africa. Following Arksey and O’Malley’s framework and PRISMA-ScR guidelines, we searched four electronic databases (PubMed, Scopus, Google Scholar, CAIRN Info) and grey literature sources. Eligibility criteria included: peer-reviewed studies published between 2000–2023 in English or French; primary research focusing on adult type II diabetes care in West African countries; and studies reporting on factors affecting access, utilisation, or quality of primary healthcare. Data were extracted using a standardised form and analysed through framework synthesis integrating the WHO Primary Health Care Framework, Social Determinants of Health model, and Innovative Care for Chronic Conditions model. Twelve studies were included from Nigeria (n=7), Ghana (n=4), and Senegal (n=1). Key barriers to access, utilisation, and quality were identified as health system deficiencies, including inadequate infrastructure, workforce shortages, supply gaps, fragmented coordination of care, absence of standardised guidelines, high costs of care, and inefficient leadership/governance for chronic disease management. Broader determinants of health, such as poverty, gender, cultural beliefs, reliance on traditional medicine, and health policy gaps, significantly influenced access to and utilisation of care. Individual-level barriers like psychological distress and delays in care-seeking were also significant. Family/social support systems emerged as potential facilitators of accessing and utilising PHC services. Our review identified that to improve diabetes care, West Africa needs context-specific models that align indigenous healing practices with PHC, strengthen health systems, and address sociocultural determinants. Future research should focus on developing and evaluating culturally resonant interventions that can navigate both biomedical and sociocultural factors shaping diabetes management in resource-constrained settings.